The Somatic Connection  |   October 2011
Osteopathic Manual Therapy Reduces Gastrointestinal Dysfunction and Length of Stay for Premature Infants in Neonatal Intensive Care Unit
Article Information
The Somatic Connection   |   October 2011
Osteopathic Manual Therapy Reduces Gastrointestinal Dysfunction and Length of Stay for Premature Infants in Neonatal Intensive Care Unit
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 570-571. doi:
The Journal of the American Osteopathic Association, October 2011, Vol. 111, 570-571. doi:
Pizzolorusso G, Turi P, Barlafante Get al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropr Man Therap. 2011;19(1):15. 
From a pool of 663 premature infants consecutively admitted between January 2005 and June 2008 to the neonatal intensive care unit (NICU) of the main public hospital in Pescara, Abruzzo, Italy, researchers from the Accademia Italiana Osteopatia Tradizionale studied 350 admitted infants who met certain inclusion and exclusion criteria. Infants were excluded if their gestational age was less than 29 weeks or more than 37 weeks; if their mothers were seropositive for human immunodeficiency virus or addicted to drugs; or if they had genetic disorders, congenital abnormalities, cardiovascular abnormalities, neurologic disorders, abdominal obstruction, intestinal perforation, pneumoperitoneum, or atelectasis. 
In a nonrandom group assignment process necessitated by the need to coordinate NICU care with the administration of therapy twice a week by osteopaths certified by the Registro degli Osteopati d'Italia, 188 preterm infants received routine neonatal care and 162 preterm infants received routine care plus osteopathic manual therapy. All preterm infants were transferred from the delivery or operating room to NICU immediately after birth. 
One outcome measure was the incidence of gastrointestinal dysfunction, recorded as the number of episodes of vomiting, regurgitation, and gastric reflux (ie, milky, bilious, or bloody content, measured only in infants with orogastric or nasogastric tubes) and the frequency of stooling and enema administration per patient care encounter. The other outcome measure was the length of stay in NICU per patient. 
Osteopathic manual therapy, which was administered on Tuesdays and Fridays, was initiated within 14 days after birth, regardless of other treatments administered. Each manipulation session lasted between 20 and 30 minutes and included evaluation and therapy based on the examination. From the data reported, it appears that most patients in the manipulation group received between 2 and 8 sessions of osteopathic manual therapy over 4 weeks or less, with a few patients receiving more sessions. The manipulation procedures were limited to indirect and fluidic techniques, including indirect myofascial and sutural spread, balanced membranous tension, and balanced ligamentous tension. The authors note that the manipulation techniques were based on “teachings of William Garner Sutherland, DO, and others.” 
The baseline characteristics and nonrandom group assignments resulted in the manipulation group having a statistically significant higher rate of inability to feed orally at admission, compared to the routine care group (P=.03). Despite that possible adverse influence, premature infants who received osteopathic manual therapy had statistically significant fewer instances of gastrointestinal dysfunction than infants who received only routine care (ie, average number of daily gut symptoms in manipulation group=28, in routine care group=60; P<.002). The manipulation group also had statistically significant shorter lengths of NICU stay than the routine care group (ie, manipulation group=28 days, routine care group=55 days; P<.001). 
The authors properly describe their study as exploratory, because there was no sham treatment condition, and it was not possible to randomly assign the patients to the control or treatment groups nor to control for such factors as need for respiratory support. The authors also point out that the study was not blinded. Furthermore, the generalization of results is limited because the study was conducted in only 1 NICU. 
Despite these limitations, this study was selected for review because of the demonstration of possible benefit from osteopathic manipulation in a high-risk population. If the study's results can be substantiated by further research, there could be great cost savings in the care of premature infants in NICUs with the application of osteopathic manipulation. Another reason for selection of this study to “The Somatic Connection” is to inform US osteopathic and allopathic physicians about the possible benefits of osteopathic manipulation for premature infants and to promote additional research in this area. 
Finally, this study is suggestive of the benefits of osteopathic manipulation for the regulation of physiologic functions—providing an example of the osteopathic tenet that the body has inherent regulatory and healing capacity that is enhanced by the application of osteopathic manipulative treatment.—H.H.K. 
   “The Somatic Connection” highlights and summarizes important contributions to the growing body of literature on the musculoskeletal system's role in health and disease. This section of JAOA—The Journal of the American Osteopathic Association strives to chronicle the significant increase in published research on manipulative methods and treatments in the United States and the renewed interest in manual medicine internationally, especially in Europe.   To submit scientific reports for possible inclusion in “The Somatic Connection,” readers are encouraged to contact JAOA Associate Editor Michael A. Seffinger, DO (, or Editorial Board Member Hollis H. King, DO, PhD (